Creativity and its link to epilepsy

Creative thinking represents one of our highest-order cognitive processes, involving multiple cortical structures and an intricate interplay between several cortical and subcortical networks. It results in novel ideas that translate to useful products or concepts. The evolutionary purpose of creativity is therefore apparent, as it advances our adaptation and survival. Elucidating the neurobiology and neuroanatomy of creative cognition is challenging because the construct of creativity is not clearly defined, and the many neuropsychological measures attempting to assess it are often biased, leading to imprecise findings. Using examples from the medical and music fields, creativity is demonstrably linked to the default mode network (DMN), which has the unique property of becoming activated at times of "quiet wakefulness," facilitating "defaulted" internally focused cognitive operations. Creative thoughts result from a process involving the activation and deactivation of the DMN as part of a dynamic interplay shared with the central executive network and affective salience network. The question is posed whether seizures originating from DMN-related cortical areas should be considered as having overlap with eloquent cortex, potentially exempting them from removal in epilepsy surgery. PLAIN LANGUAGE SUMMARY: Creative thinking is a higher-order cognitive process involving multiple brain structures and networks. It results in insightful and original thoughts that translate to useful products or concepts, which allow us to adapt to our surroundings. This Narrative Review presents conceptual, investigational, and neurobiological aspects of creativity, including information about a unique brain network termed "default mode network (DMN)," which activates at times of "quiet wakefulness," facilitating internally focused cognitive operations. The review ends with a discussion on whether regions of the DMN from which seizures originate should be regarded as "eloquent" and their removal should be deferred by epilepsy surgery.